Delaware Prison Health Care: Moving in the Right Direction

There have been monumental improvements under Bureau of Prison Healthcare Services chief James Welch, according to the U.S. Department of Justice’s 2009 amended memorandum of agreement.

The memorandum was issued after three years of monitoring DOC efforts to rectify about 80 health care and mental health system issues that were spelled out in a 2006 memorandum of agreement.

This followed a 2006 federal investigation of routine care expansion, chronic care overhaul and quality of nutritional offerings.

The changes have produced better outcomes: the number of patients with high cholesterol shrank from 8 percent to 4 percent, and high blood sugar dropped from 16 percent to 11 percent, according to data collected by DOC in 2008 and 2010. These factors are related to heart problems and diabetes.

Still, some factors are out of DOC’s hands.

Take the 1976 federal ruling that charges prisons to meet the serious medical needs of inmates. Welch says that a state budget leaves little room for more than a medically necessary standard, which limits how much a medical staff can do. The ramifications of waiting to address problems until they are serious can be harsh for seniors with increasingly complex medical issues.

State Rep. James Johnson, a member of the Joint Finance Committee and chair of the House Corrections Committee, says the legislature, in recent years, has approved DOC’s budget requests.

“The governor presents a budget based on discussions between the Office of Management and Budget and the departments [including DOC] run by the governor’s cabinet, so our role [as legislators] is more perfunctory,” Johnson says. “The DOC has gotten what they’ve asked for in the budget the last several years.”

DOC commissioner Carl Danberg says the prison health care budget is based on several factors.

“Medical costs make up a significant portion of our annual budget,” he says. “We need to maintain the standard of care required by the U.S. Supreme Court and described in our MOA with the U.S. Department of Justice. These health care services are placed out to bid and the cumulative total of the vendor contracts comprise that portion of our budget.”

Another factor that affects DOC’s ability to provide proper health care are the prisoners themselves.

“The reality is that we have some manipulative, dangerous patients here. We have to be sensible,” says Dr. Dale Rodgers, infirmary physician at Vaughn Correctional Center. “Everyone gets immediate care in an emergency, but you can’t send dangerous people out to the community just because they have a headache. We scrutinize to avoid wasted trips.”

The medically necessary and safety first mandates might help explain stories like that of the elderly cancer patient who was granted parole so he wouldn’t die in prison.

“He got medication outside,” says Amir. “Years later, looks like he never had cancer.” Those who hear such stories or experience them firsthand believe that staffers weren’t trying hard enough.

That may be true, despite a five-year federal monitoring system that rendered monumental improvements.

Today, more diagnostic and treatment options are available in-house at Vaughn Correctional Center in Smyrna, where most long-term inmates and prisoners with chronic medical conditions are housed. The prison now offers physical therapy, a negative pressure room for patients with tuberculosis, a dialysis unit, dental and optometry services, X-ray facilities and stat blood work for quicker diagnosis.

Staffing improvements include additional nursing leadership at each prison to coordinate chronic care clinics, a new nurse trainer dedicated to health education to help patients better manage their chronic conditions, patient empathy training for staff, an enhanced physician assistant clinical training program and a new social work intern program.

Welch says he is especially proud of the new Continuous Quality Improvement Program. The Web-based auditing system simultaneously monitors medical services for quality and identifies glitches in the delivery of services as they arise. He says this evidence-based system improves care by re-prioritizing a particular medical service’s level of scrutiny and intervention based on feedback.

There have been dramatic improvements because the auditing system lets everyone know what’s actually going on, says Schwind, of the Public Defender’s Office. She says DOC staff has been very responsive, whereas before her tenure, a response was weeks in coming, if ever. She says her communications are answered quickly, often within a few hours.